04.2 Stomach conditions

Stomach Conditions

• This lecture covers common stomach conditions like GERD, gastritis, and peptic ulcer disease.
• It details their presentations, investigations, complications, and pharmacological treatments.
• A key focus is reducing gastric acid secretion and the role of Helicobacter pylori.

Learning Objectives

• Describe the presentation, investigations, and complications of GERD, gastritis, and peptic ulcer disease.
• Outline pharmacological interventions for reducing gastric acid secretion.
• Explain the role of Helicobacter pylori in chronic gastritis and its effects on gastric physiology.

Key Concepts and Definitions

• GERD (Gastroesophageal Reflux Disease): A condition where stomach contents flow back up into the esophagus. Symptoms include chest pain, regurgitation, and coughing.
• Gastritis: Inflammation of the stomach lining. It can be acute (due to things like NSAIDs or alcohol) or chronic (due to infections like H. pylori or autoimmune issues).
• Peptic Ulcer Disease (PUD): A sore or erosion in the lining of the stomach or duodenum. Often caused by H. pylori or NSAID use.

Clinical Applications

• Case Study: A 45-year-old male with chest pain, a burning sensation worsened by alcohol and coffee, relieved by antacids, with a history of smoking and blood pressure medication.
• Diagnosis: Often clinical, but endoscopy or esophageal manometry may be used for patients with alarm symptoms or resistant cases.
• Treatment options: Lifestyle modifications, pharmacological agents like H2 antagonists (e.g., ranitidine) or PPIs (e.g., omeprazole), and rarely surgical interventions like Nissen fundoplication.

Pathophysiology

• GERD: Lower esophageal sphincter (LES) incompetence lets stomach contents flow back up. Dysfunction may be due to transient relaxations, hypotension, or anatomical issues like a hiatal hernia.
• Gastritis: Acute gastritis from direct mucosal damage by irritants (NSAIDs, alcohol). Chronic gastritis from prolonged inflammation via H. pylori or autoimmune issues.
• Peptic Ulcer Disease: Ulcers develop from an imbalance between aggressive factors (acid, pepsin) and protective factors (mucus, bicarbonate). Chronic ulcers can perforate or cause bleeding.

Pharmacology

• H2 Antagonists: Drugs like ranitidine and cimetidine reduce acid secretion by blocking H2 receptors on parietal cells.
• Proton Pump Inhibitors (PPIs): Drugs like omeprazole inhibit the H+/K+ ATPase, the final step in acid secretion, thus reducing stomach acidity.

Differential Diagnosis

• GERD: Distinguish from angina, esophageal motility disorders, and functional dyspepsia.
• Gastritis: Rule out peptic ulcer disease and gastroenteritis.
• Peptic Ulcer Disease : Consider pancreatitis or biliary colic.

Investigations

• OGD (esophagogastroduodenoscopy): to visualize the esophagus, stomach, and duodenum, often in cases with alarm symptoms or persistent conditions.
• Urea breath test or stool antigen test: to diagnose H. pylori infection.

Medical Conditions of the Lower Esophageal Sphincter

• Achalasia: Nerve endings in the esophagus cause inability to swallow or pass food
• Acid reflux: Stomach acid and food particles rise into the esophagus as the lower esophageal sphincter (LES) does not close tightly enough.
• Hiatal hernia: Part of the stomach pushes up through the diaphragm
• Hypertensive lower esophageal sphincter: Involves increased muscle contraction

Summary and Key Takeaways

• GERD, gastritis, and peptic ulcer disease share overlapping symptoms but have different underlying causes.
• H. pylori is a significant factor in chronic gastritis and peptic ulcer disease. Eradication is crucial.
• Lifestyle modifications and pharmacological treatments (H2 antagonists and PPIs) are the first lines of therapy for reducing gastric acid secretion.

Questions/Clarifications

• Question 1: What is the role of lifestyle modifications in long-term GERD management?
• Question 2: How does long-term PPI use affect electrolyte balance, especially magnesium levels?

This quiz focuses on common stomach conditions such as GERD, gastritis, and peptic ulcer disease. It explores their symptoms, investigations, complications, and the pharmacological treatments available, including the role of Helicobacter pylori. Test your understanding of these gastrointestinal disorders and their management.